Health
Survey

Part
1 - Pain & Toxicity Assessment Test
Use the drop down selection to answer Yes or No

If the total number of symptoms is 4 or greater,
it might be due to toxic overload and you need a metabolic
detox for pain inflammation and fatigue.

Do
you feel tied or fatigued?

Do you experience
early morning stiffness?

Do you feel stiff
after periods of rest?

Do you feel dizzy,
foggy-headed or have trouble concentrating?

Do you experience
cracking joints?

Do you experience
frequent back pain or headaches?

Do you eat fast,
fatty, processed or fried foods?

Do you experience
generalized aches and pains in the body?

Do you use coffee,
cigarettes, candy or soda to get energy?

Are you sleepy
in the afternoon?

Do you bruise
easily?

Do you recover
slowly from moderate exercise?

Do you have food
allergies, or are often exposed to chemicals, sedatives or stimulants?

Do you take pain
relievers to get rid of aches and pains?

Do you have a
family history of arthritis or auto-immune disorders?

Total
number of symptoms

Part
2 - Bio-Inflammation Symptoms Questionaire
Rate each of the following symptoms based upon your typical
health profile:

Point Scale:
0 - Never or almost never have the symptoms
1 - Occassionally has it, effect is not severe
2 - Occassionally has it, effect is severe
3 - Frequently has it, effect is not severe
4 - Frequently has it, effect is severe

If any individual section total is 10 or more,
or the Grand total is 50 or more, you may
benefit from a detoxification program.